December 9, 2008
IC Directors
Penny Burgoon
IC Directors’ Meeting Highlights – November 13, 2008

Discussion Items

Dr. Kington began the IC Directors meeting announcing that Dr. Larry Tabak had accepted the position as acting Deputy Director of NIH. Dr. Tabak will also continue his position as Director of NIDCR during this time. Dr. Kington left the meeting to testify at a House hearing on Protecting Heath Care and Biomedical Research and turned the meeting over to Dr. Tabak.

Dr. Tabak welcomed everyone to the meeting and recognized Dr. Ken Warren his new capacity as acting director of NIAAA. Dr. Marie Bernard was also greeted as the new deputy director of NIA.

Combined Federal Campaign update: John Niederhuber, NCI

Dr. John Niederhuber provided an update on the Combined Federal Campaign. At the halfway point of the Campaign, NCRR currently leads all ICs with an 80% participation rate. Given constrained budgets, this year’s focus has been on participation of the ICs, rather than total amounts of contributions. Dr. Niederhuber asked IC Directors to encourage their Executive Officers and CFC coordinators to motivate their staff to participate in the Campaign.

White Paper on Global Health and International Report on NIH Investments in Global Health: Roger Glass, FIC

Dr. Glass presented two recent efforts to examine NIH’s engagement and investments in international biomedical research—a white paper to examine NIH’s global engagement in biomedical research and a report on NIH Investments in Global Health.

As an outcome of the 2007 Leadership Forum, the white paper was developed by a small group of IC Directors which included Dr. Fauci, Dr. Hodes, Dr. Nabel, and Dr. Niederhuber. The white paper describes the working principles and rationale that have guided NIH international investments and key scientific and organizational challenges in advancing international programs Dr. Glass suggested that white paper be used to build awareness of NIH’s role and contributions to global health and the role of biomedical science in advancing global health and economic and social stability. He proposed that the document be shared with the IOM Committee on the US Commitment to Global Health, convened to update a 1997 IOM report on US engagement in global health.

As an outcome of discussions, the IC Directors requested the working group to organize a one-day retreat to enable ICs to share information and perspectives on international program strategies, common obstacles, and innovative program models Among other aims, the retreat will explore whether there is benefit in forming a trans-NIH group to help advance NIH's international activities

The Report on NIH International Extramural Investments in Foreign Institutions FY 2004 – FY 2005 should be used for internal purposes only as reporting of this data to external groups should be conveyed in total NIH figures on Global Health, rather than being specified by IC. The report establishes a quantitative baseline for understanding NIH’s investments in Global Health by capturing support of foreign research institutions and funding trends, support for training of foreign researchers or US researchers at foreign sites, and identifying a foreign component of domestic awards as some examples. However, this effort also revealed that existing enterprise databases cannot comprehensively and accurately report on international activities and a recommendation was made to convene a trans-NIH group to develop and implement an international activity data management system.

Learning What Works Best in Medical Care—Emerging Priorities: Dr. J. Michael McGinnis, Institute of Medicine

Dr. McGinnis from the Institute of Medicine (IOM) gave a presentation on evidence-based medicine and emerging priorities affecting medical care. Health has become a leading policy concern for Americans, ranking behind only economy at the top of the list but an integral part of that issue as well. The application in clinical medicine of guidelines strongly supported by evidence has remained low, while the share of clinical interventions poorly supported by evidence is high. This has led not only to shortfalls in the quality of care, but to substantial waste in the prevalent practice patterns. With huge projected expenditure growth for Medicare and Medicaid, the current patterns are unsustainable (federal health expenditures alone will account for more than 20% of the entire economy by 2050. The need is already substantial for better evidence on which to base strategies around high value care, and yet will grow larger as the explosion in research on genetic genetics compels better targeting of interventions against common diseases.

Yet, currently, even the limited efforts to assess clinical effectiveness—especially comparative effectiveness—are poorly coordinated and redundant. Comparative Effectiveness Research (CER) has become a major policy interest. It seeks to systematically compare and review existing studies and interventions at hand to provide a better evidence-base for choice among available alternatives for diagnosing and managing a particular condition. CER activities and needs were outlined for the operation of a CER entity, with distinctions between the scientific and the policy-related functions.

A matrix of CER enterprise models was discussed, comparing Federal, Independent or a hybrid (Federal and Independent) groups and their ability to address entity functions. A primary challenge, in all cases, would be continuous improvement of the evidence base for determining delivery decision rules. Emerging techniques and technology for continuous evidence collection will be an important part of the decision framework as the current evidence base largely relies on static information. Another important challenge will be determination of delivery decision rules as the evidence base changes and grows (e.g. changes in the nature of evidence, the sources of evidence, the structure of evidence standards, the application of evidence, the understanding of evidence, and the relation between evidence-based medicine and best practice).

The IOM is addressing these challenges through the creation of its Roundtable on Evidence-Based Medicine, comprised of CEOs from various sectors, and working to identify and engage the key elements of a Learning Heathcare System. It is doing this through a series of meetings and reports related to the broad range of issues and opportunities, and through the creation of broad multi-stakeholder Collaboratives in effectiveness research innovation, electronic health records, best clinical practices, and evidence communication.

Penny Burgoon
cc: OD Senior Staff

This page was last reviewed on December 22, 2008 .
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